Investing Questionnaire
CLIENT INFORMATION
INFORMATION
CLIENT
SPOUSE/2ND PARTY
$
$
$
$
Name:
Date of Birth:
Employment status:
Annual earned income (before
taxes):
Annual income from investments:
Annual income from other
sources:
$
$
DEPENDENT INFORMATION
NAME
DOB
GENDER
ASSETS & LIABILITIES
CASH ASSETS (emergency funds, money markets, checking, savings, etc.):
DESCRIPTION:
OWNER:
CURRENT VALUE:
INVESTMENT ASSETS (stocks, bonds, non-retirement mutual funds, etc.):
DESCRIPTION (tax free or tax
deferred):
OWNER:
CURRENT VALUE:
BUSINESS/REAL ESTATE ASSETS (business building, rental property, etc.):
DESCRIPTION:
OWNER:
CURRENT VALUE:
PERSONAL ASSETS (home, 2nd home, jewelry, art, etc.):
DESCRIPTION:
OWNER:
CURRENT VALUE:
STOCK OPTIONS of a publicly traded company:
DESCRIPTION:
OWNER:
CURRENT VALUE:
RETIREMENT ASSETS OF CLIENT (401-k, 403-b, SEP, Roth IRA, Traditional IRA, etc.):
CURRENT
ANNUAL EMPLOYER
TYPE:
VALUE:
ANNUAL CONTRIBUTION:
CONTRIBUTION:
RETIREMENT ASSETS OF SPOUSE/2ND PARTY (401-k, 403-b, SEP, Roth IRA, Traditional IRA, etc.):
ANNUAL EMPLOYER
TYPE:
VALUE:
ANNUAL CONTRIBUTION:
CONTRIBUTION:
Liabilities/Debt Obligation (consumer loans, automobile loans, mortgages, home equity loan, etc.):
RESPONSIBLE
CURRENT
MONTH
TYPE:
PARTY:
BALANCE:
PMNT:
% RATE
TAX DEDUTCTIBLE?
$
$
Yes:
No:
$
$
Yes:
No:
$
$
Yes:
No:
$
$
Yes:
No:
$
$
Yes:
No:
INCOME PROTECTION
Life Insurance - CLIENT:
TYPE:
OWNER:
BENEFICIARY:
DEATH
BENEFIT:
CASH
VALUE:
ANNUAL PREMIUM:
$
$
$
$
$
$
DEATH
BENEFIT:
CASH
VALUE:
ANNUAL PREMIUM?
$
$
$
$
$
$
Life Insurance – SPOUSE/2ND PARTY:
TYPE:
OWNER:
How important is it to provide
financial resources for your
spouse, dependents, or others, in
the case of your death?
BENEFICIARY:
Very
Somewhat
Neutral
Somewhat
unimportant
Unimportant
SPOUSE/2ND PARTY:
CLIENT:
Do you have a plan, at work, or
individually, which provides
continuing income if you are
unable to work due to accident or
illness?
YES:
What %age of your income will be
replaced by this plan?
__________%
__________%
How many years of coverage
does this plan provide?
__________Years
___________Years
CLIENT:
< 8 weeks
months
SPOUSE/2ND PARTY:
< 8 weeks
months
How long could you live on your
current assets in the event you
become disabled or suffer a
prolonged illness?
NO:
YES:
2-6
6-12 months
>1
NO:
6-12 months
2-6
> 1 year
year
How important is it to replace
your earned income in the event
you become disabled or suffer a
prolonged illness?
Are you financially prepared for
high costs associated with long
life in retirement, such as longterm care?
Do you have any parents,
siblings, etc., that may become
your financial dependent?
How important is it to provide
long-term care funding for you,
your spouse, or our dependents?
Very
Somewhat
Neutral
Unimportant
Yes
No
Yes
No
Very
Somewhat
Neutral
Unimportant
FINANCIAL CONCERNS
CLIENT:
No will
When did you last review
your will?
3-7 Years
SPOUSE/2ND PARTY:
No will
< 3 Years
> 5 Years
3-7 Years
< 3 Years
> 5 Years
How important is it to reduce or eliminate your debt?
Very
Unimportant
Somewhat
Neutral
How important is it to consolidate your debt?
Very
Somewhat
Neutral
Somewhat
Neutral
Somewhat
Neutral
Somewhat
Neutral
Somewhat
Neutral
Unimportant
How important is it to accumulate funds for future goals
besides retirement and education goals?
Very
Unimportant
How important is it for you to have assistance in
reviewing your different IRA choices, i.e., Roth vs
Traditional, etc.?
Very
Unimportant
How important is it for you to have assistance in moving
retirement funds from a previous employer?
Very
Unimportant
How important is it for you to have assistance in
reviewing your investments?
Very
Unimportant
RETIRMENT PREPARATION
What age do you
CLIENT: ____________
want to retire?
On average, what percentage of your combined
income (after tax) do you feel you will need when you
retire to live comfortably?
How much impact do you feel inflation will have on
your retirement?
SPOUSE/2ND PARTY: ____________
___________________%
Major
Some
SPOUSE/2ND PARTY
CLIENT
If you are employed, does your
employer provide a defined benefit
pension plan?
Yes
Not sure
No
Yes
No
EDUCATION PLANNING & LIFE EVENTS
Do you plan to (help) fund the
educational needs of your children, etc.?
Approximately what amount of money do
you anticipate needing to fund these
college/graduate school needs?
Do you feel you are adequately
prepared to fund these needs?
Do you anticipate any of these life
changing events in the next year?
Yes
$_____________College
No
$_____________Graduate School
Yes
No
Please circle:
Change of employment
Starting a new business
Birth of a child
Dependent entering college
Major (home, etc.) purchase
Retirement
RISK TOLERANCE
Do you agree with the
statement “reducing losses is
more important than
receiving high returns?”
How comfortable are you with
risk?
Strongly agree
Agree
Somewhat disagree
Lower risk/lower return
Disagree
Moderate risk/moderate return
High risk/higher return
How would you describe your
investment philosophy?
I want my investments to consistently generate a steady return. (This
usually translates to a low level of risk tolerance.)
I am not concerned about periodic fluctuations and understand that this
could mean some large losses. (This usually translates to a medium level of
risk tolerance.)
I am comfortable with a portfolio that will lose and regain value, over
time, with an understanding that, overall, the rate of return will be higher than
average. (This usually translates to a high level of risk tolerance.)
If the value of your
investments fell 20% in one
year, what would your
reaction be?
I would be inclined to move my money in to a different investment.
I would be concerned and consider moving my money in to a different
investment.
I would leave my money alone and continue to invest according to my
long-term plan.
I would leave my money alone and probably invest more.
What life stage of investing
are you currently in?
Early years
Middle years
High income & savings years
Early retirement years
Retirement